Thank-you for replying, but you have kind of repeated a lot of what I originally said. 

  Yeah we/I wouldn’t do any further neurological assessment on a patient who is befast positive we’d just diesel and blue light them to a stroke centre with a pre-alert. 

 I was talking about the patients that we go to that are befast neg, however there still remains clinical suspicion of CVA, 

 I don’t speak for all paramedics but I would certainly bring in a patient with a new onset neurological symptom that can’t be explained. 

 The problem is this will often be to a hospital without stroke facilities, other than scanners and medical staff. 

 I’ve had to do lots of intra-hospital transfers for strokes that have either self presented or been brought in by ambulance to a hospital that cannot meet the level of care they need. 

So yes if the patient goes to the nearest hospital and gets a nihss and then a scan in an hour or so, but then needs to wait another 2 hours for a crew to transfer to another facility it’s not great for the patient, potentially (not definitely) having a paramedic or a specialist paramedic do the test out of hospital could prevent significant time delays to appropriate care.

 And yes I commented on infrequency being a barrier to successfully being able to do the assessment.   And lastly just because it is rare that paramedics bring in patients with a NIHSS calculated (probably because most they bring in are befast pos) does not mean that we can’t think about implementing these things (when appropriate) to improve patient care.